Individual provider Active NPI

Courtney Melissa Woolston, AGPCNP-BC

  • Primary Care Nurse Practitioner
  • Meridian, ID
National Provider Identifier
1710316526
Registry record updated Nov 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
NP-1358A Issued in ID
Practice address
2112 E Franklin Rd
Meridian, ID 83642-9024
Phone
(180) 023-0752
NPI assigned
Nov 2, 2013
Last updated
Nov 2, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X NP-1358A ID Primary

Addresses

Primary practice location

2112 E Franklin Rd
Meridian, ID 83642-9024

Mailing address

2112 E Franklin Rd
Meridian, ID 83642-9024

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171205002090 ID Practitioner - Nurse Practitioner 6305103060 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

1118 NW 16TH St
Suite D
Fruitland, ID 83619-2272
Phone (208) 452-7677

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP-1358AIDMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Nov 1, 2017 Accepting new patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Nov 1, 2017 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

1118 NW 16th St
Ste D
Fruitland, ID 83619
Phone (208) 452-7677

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383350400000",
    "number": "1710316526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2112 E FRANKLIN RD",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836429024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2112 E FRANKLIN RD",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836429024",
            "telephone_number": "180-023-0752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOLSTON",
        "first_name": "COURTNEY",
        "middle_name": "MELISSA",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-02",
        "last_updated": "2013-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "ID",
            "license": "NP-1358A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.